Showing papers by "Richard M. Frankel published in 2000"

Study design in qualitative research--2: Sampling and data collection strategies.

Abstract: In two prior papers in our series on qualitative research (Frankel & Devers (2000a, 2000b) Qualitative research: a consumer's guide, Education for Health, 13, 113-123; Frankel & Devers (2000) Study design in qualitative research—1: developing research questions and assessing research needs, Education for Health, 13, 251-261), we examine two critical issues in qualitative research design: sampling, including identifying and negotiating access to research sites and subjects, and data collection and management We describe these two key steps in the qualitative research design process, discuss challenges that often emerge when pursuing these steps, and provide guidelines for addressing them Qualitative research most often uses "purposive," rather than random, sampling strategies A good understanding of these sampling strategies and why they are used is central to designing a credible qualitative study In addition, given the real-world context in which most qualitative research is carried out, identifying and negotiating access to research sites and subjects are critical parts of the process We also provide suggestions for developing and maintaining productive and mutually satisfying research relationships with sites and subjects Finally, data collection and management are often neglected subjects in qualitative research We offer practical advice on how to collect and manage qualitative data, including factors to consider when deciding how struc- tured the data collection process should be, the pros and cons of audio- and/or videotaping compared with note-taking, and tips for writing up eeld notes and document management A forthcoming, enal paper in the series will focus on qualitative data analysis and the publication of qualitative research results

Study design in Qualitative research - 1: Developing questions and assessing resource needs

Abstract: This is the second in a series of four papers on understanding and doing qualitative research [Frankel & Devers (2000) Qualitative research: a consumer's guide, Education for Health, 13, 113-123; Devers & Frankel (2000) Study design in qualitative research--2: sampling and data collection strategies, Education for Health, 13, 263-271]. Here, we focus on problems of study design, including question development, literature review, identifying a target audience and resource needs assessment. We provide a step-by-step description of major issues and choice points in the process. There are three key differences between qualitative and quantitative research designs. First, the logic of qualitative research is often inductive, rather than deductive, and consists of describing people's and groups' particular situations, meanings and experiences. Second, qualitative research designs are often emergent and flexible, and the research itself is quite dynamic. Third, the qualitative research process is non-linear and non-sequential. There is agreement that good qualitative studies answer clearly stated, important research questions. How qualitative research questions are formulated has implications for conducting a literature review. Some scholars believe that literature should be reviewed prior to beginning a study; others argue that this may impede the researcher from truly listening, observing and remaining open to new concepts and ideas. We offer suggestions about formulating research questions and how and when to conduct a literature review. Another important issue in conducting qualitative research is determining the resources that will be needed to conduct a study. These include internal resources, such as research skills, and external resources, such as personnel (expertise and time), equipment, supplies and travel. A description of typical resource and management issues in conducting a qualitative research study is included.

The path to professionalism: cultivating humanistic values and attitudes in residency training.

Abstract: Though few question the importance of incorporating professionalism and humanism in the training of physicians, traditional residency programs have given little direct attention to the processes by which professional and humanistic values, attitudes, and behaviors are cultivated. The authors discuss the underlying philosophy of their primary care internal medicine residency program, in which the development of professionalism and humanism is an explicit educational goal. They also describe the specific components of the program designed to create a learner-centered environment that supports the acquisition of professional values; these components include a communication-skills training program, challenging-case conferences, home visits with patients, a resident support group, and a mentoring program. The successful ten-year history of the program shows how a residency program can enable its trainees to develop not only the requisite excellent diagnostic and technical tools and skills but also the humane and professional attributes of the fully competent physician.

Qualitative research: a consumer's guide.

Abstract: Qualitative research is best characterized as a family of approaches whose goal is understanding the lived experience of persons who share time, space and culture. Although they are often judged as a single entity, the approaches actually vary in their theoretical assumptions and canons of evidence. Four qualitative research domains that are currently used in studying education for health are reviewed here. They are ethnographic/field work approaches, use of interviews and surveys, audiovisual records, and the study of documents. Characteristics of each domain and brief examples are provided. In addition to introducing the four research domains, we offer some general guidelines on how to be a good consumer of qualitative research. We pose a series of questions about the importance of the research question, study design, and trustworthiness of qualitative research results. In addition, we focus on how research results are presented and discussed. We conclude with the observation that qualitative research approaches are only as good as the questions they set out to illuminate. In the arena of education for health a number of good and important questions remain unaddressed and would benefit by being studied using qualitative research approaches.

Overcoming cultural barriers: international medical graduates in the United States.

Abstract: OVER THE PAST 5 YEARS, MORE THAN 20000 GRADUATES OF FOREIGN medical schools have entered residency programs in the United States to obtain graduate medical education. The vast majority of these international medical graduates (IMGs) have gone on to practice in the United States after completing their training. Consequently, the number of IMGs has risen steadily reaching nearly 25% of all allopathic physicians practicing in the United States. Considerable controversy surrounds this influx of physicians from abroad at a time when the US health care system is undergoing dramatic change. Concern over a potential physician surplus has caused several prominent policy groups to call for a cap on the numbers of foreign national IMGs permitted to remain permanently in the United States. With growing pressure to curb Medicare reimbursements to teaching hospitals, policy analysts have also questioned the allocation of funds for graduate medical education to pay for residency positions for IMGs. Supporters of the open-door policy toward IMGs have countered that these physicians practice in disproportionately high numbers in areas of the country that have been neglected by the US health care system. For some time, workforce experts have debated whether such IMGs provide a national service by alleviating the geographic maldistribution of physicians throughout the country. Others ask why the United States, with its overall wealth and burgeoning medical education system, is not able to provide care in so many of its communities using physicians trained in its own medical schools At the same time, the widespread perception that IMGs receive inferior training in foreign medical schools continues to dog IMGs’ efforts to prove that they provide quality care to these communities. The creation of the new Clinical Skills Assessment (CSA) exam as a requirement for IMGs seeking entry into a US residency program is evidence of concern that IMGs do not have adequate clinical and interpersonal skills to care for US patients. This issue of MSJAMA explores some of the questions raised by IMGs’ controversial presence in the United States. How have recent immigration restrictions on foreign national physicians changed the composition of the US physician workforce? To what extent do IMGs provide care to segments of the population that have traditionally been neglected by US medical graduates? What sort of cultural barriers must IMGs overcome inordertodelivercaretopatientsintheUnitedStates?Whatroledoclinicalbasedexamssuchas theCSAplay instandardizing thequalityofcareprovided by all graduates entering residency training?

What Residents Want to Know About Geriatrics: An Approach to Curriculum Development

Abstract: Focus group analysis, a qualitative research method involving group interviews, was used to explore resident physicians' experiences with older patients. Content analyses of three groups of resident physicians from five residency programs in an urban community identified several important themes in regard to caring for older patients and revealed strong emotional responses to caring for older patients. Implications for designing improved geriatrics curricula are presented. Residents emphasized the need for additional training in communication skills as well as broadening the scope of settings where geriatric education takes place. It is recommended that similar studies be conducted at other medical centers in order to better inform revisions in geriatric education.

The Effect of Confirming Management Earnings Forecasts on Cost of Capital

Abstract: This study examines the market response to confirming forecasts. Confirming management forecasts are voluntary disclosures by management that corroborate existing market expectations about future earnings. The study of confirming forecasts is important because it can provide evidence on the relation between voluntary disclosure and cost of capital. We find that the market's reaction to confirming forecasts is significantly positive, indicating that benefits may accrue to firms that disclose such forecasts. In addition, while we find no significant change in the mean consensus forecasts (a proxy for earnings expectations) around the confirming forecast date, evidence indicates a significant reduction in the mean and median consensus analyst dispersion (a proxy for earnings uncertainty). Finally, we document a positive association between reduction of dispersion of analysts' forecasts and the magnitude of the stock market response.